Long Term Disability Insurance Claims For Police Officers

J.P. Gonzalez-Sirgo
Founder of J.P. Gonzalez-Sirgo, P.A.

What are some common ways of getting injured on the job as a Police Officer?

Law Enforcement Officers are tasked with protecting and serving people, and property. A typical day can entail anything from patrolling areas, responding to calls, writing citations, making arrests, or providing aid to those in distress. Law Enforcement Officers are often the first line of defense, and generally the point of inception between an individual and the judicial system. While most people hope they never have to call Law Enforcement, everyone is glad that they can rely on Law Enforcement in their time of need.

Despite how demanding Law Enforcement can be, police officers are ordinary people. As ordinary people, they are susceptible to injury and sickness. Because of the nature of the career, Law Enforcement Officers have a higher risk of becoming injured on the job than most other professions. The Bureau of Labor Statistics estimates that in 2014, Law Enforcement Officers experienced over 27,000 work related injuries and illnesses that resulted in the Officer having to spend at least a few days away from work to recover. The most common non-fatal work-related injury that Police Officers experienced in 2014 involved violence from persons or animals. The second most common form of injury resulted from falls, slips, or trips. Injuries resulting from fires and/or explosions produced the third most common form of non-fatal work-related injury to Officers. The fourth most common cause of injury involved some form of transportation incident, such as car accidents.

What is the Heart/Lung Bill, and how does it affect your worker’s compensation benefits?

If you’re injury or sickness is considered to have been work-related, then worker’s compensation laws will likely govern your claims. It is also likely that long-term disability benefits, that otherwise would have been covered by your insurance policy, will be offset by your worker’s compensation benefits. On the other hand, if you’re injuries are not work-related, or you cannot demonstrate that they are work-related, then long-term disability benefits are meant to fill the gaps in loss of income resulting from your disability. Whether you will be awarded long-term disability benefits, however, depends on the terms of your policy.

In Florida, there is a special piece of legislation commonly known as the “Heart/Lung Bill” that provides extra protection for Law Enforcement Officers that suffer from heart disease, tuberculosis, or hypertension resulting in death, or disability. In essence, the statute states that when an Officer develops any of these conditions, there is a presumption in favor of the Officer that the cause of such condition is work-related. The presumption can be rebutted by a showing of competent evidence that the cause of the condition is not work-related. However, if the Officer can proffer evidence that the cause of the condition was in fact work-related, the standard the employer must meet to defeat the presumption is clear and convincing evidence (a much higher burden to meet). Over the years, amendments to the statute have narrowed the scope of its protection. For example, the statute now states that if the Officer “departed in a material fashion from the prescribed course of treatment of his or her personal physician” and this departure can be shown to have significantly aggravated the condition, then the presumption will not apply and the Officer will likely be unable to recover worker’s compensation benefits. A common example of such deviation involves a departure from a recommended nutritional plan.  

What is long-term disability insurance?

A long-term disability policy is a contract in which the Officer has agreed to pay premiums in exchange for the insurer’s promise to pay the Officer a certain amount of pre-disability income in the event that the Officer becomes disabled for an extended period of time. A typical policy provides that long-term disability benefits will be paid if the disability persists for longer than 180 days. As with all contracts, the terms that you have agreed upon will govern your specific rights. Some policies tend to provide more protection, while other policies tend to provide less.

Generally, these can be characterized as either “own occupation” or “any occupation” policies, and while the difference seems subtle, it often means the difference between receiving disability benefits, and not receiving anything at all. Under an “own occupation” policy, your right to receive benefits depends on whether your disability prevents you from substantially and materially performing the duties of your particular occupation. For Law Enforcement Officers, this can mean loss of mobility, impaired vision or hearing, developing mental or physical health conditions, etc. If you cannot perform the typical duties associated with being a Law Enforcement Officer, the own occupation policy will provide income protection. On the other hand, the “any occupation” policy is much more insurer-friendly, and often forms the basis of your denial. Under this type of policy, you will not be entitled to receive disability benefits if you can still perform other occupations that you are qualified to perform even if you cannot perform the duties associated with being a Law Enforcement Officer.

Which laws will govern your disability claim, and why does it matter?

As a Police Officer you are employed by a government entity and you are probably insured for long term disability insurance under a group plan.  Typically, the effect of being insured under a group plan is that your claim will be governed by an anti-consumer and complicated federal law, known as ERISA. However, ERISA does not apply to government employees.  As such, a denial of your claim will be governed by Florida law. Normally, this will be under a breach of contract theory, or the like, and you can generally file a lawsuit to enforce your rights under the contract at any time.

If your long term disability benefits have been denied, then it is very important that you contact an experienced lawyer as early as possible. Often times, it can mean the difference between receiving benefits, and not receiving anything at all.

You can reach Miami Long Term Disability Insurance Claims Lawyer J.P. Gonzalez-Sirgo by dialing his direct number at (786) 272-5841, calling the main office at (305) 461-1095, or Toll Free at 1 (866) 71-CLAIM or email Attorney Gonzalez-Sirgo directly at [email protected].

Sources

https://www.bls.gov/iif/oshwc/cfoi/police-officers-2014.htm

FL. Stat. §112.18

29 U.S. Code Chapter 18 - EMPLOYEE RETIREMENT INCOME SECURITY PROGRAM